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STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT

STATE: Virginia Page 4-18

Effective Date: 07/01/05

18 Approval Date: _____________/06 was discontinued for reasons unrelated to payment of premiums. 4. Insurance was discontinued by a family member who was paying the full cost of the insurance premium under the COBRA policy and no other family member contributes to the cost of family health insurance coverage. 5. Insurance on the child was discontinued by someone other than the child (if 18 years of age), or, if under age 18, the child’s parent, or step-parent, e.g., the insurance was discontinued by the child’s grandparent, aunt, uncle, godmother, etc. 6. Insurance on the child was discontinued because the cost of the premium exceeds 10% of the family’s gross monthly income or exceeded 10% of the family’s gross monthly income at the time the insurance was discontinued. 7. Other good cause reasons as may be established by the DMAS Director.

Staff at the central site reports information to DMAS, which will monitor the trends in health insurance coverage for children enrolling in FAMIS to determine the degree substitution is occurring. Assignment of rights to medical support is a condition of eligibility.

4.4.4.2. Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

4.4.4.3. Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4 If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.